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Step 2 DIT 😱 > Associations 1 > Flashcards

Associations 1 Flashcards

1
Q

Meningitis + petechiae/purpura

A

Neisseria meningitis

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2
Q

Temporal lobe encephalitis + skin lesions

A

Herpes simplex virus

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3
Q

Meningitis + AMS

A

Encephalitis

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4
Q

WNV animals

A

Birds are reservoir, mosquitoes are vector

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5
Q

Virus + ASA

A

Reye syndrome (brain + liver)

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6
Q

Ring enhancing lesion on MRI

A

Brain abscess

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7
Q

Poliomyelitis

A

Destroys motor neurons (flaccid paralysis)

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8
Q

Negri bodies (eosinophilic inclusions in neurons)

A

Rabies

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9
Q

HA made worse by foods w/ tyramine

A

Migraine

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10
Q

HA in obese woman w/ papilledema

A

Pseudotumor cerebri

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11
Q

Jaw muscle pain when chewing

A

Temporal (giant cell) arteritis

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12
Q

Periorbital pain w/ ptosis and miosis

A

Cluster HA

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13
Q

Horner’s syndrome - 2 causes

A 
Ptosis, miosis, anhydrosis
Pancoast tumor (apex of lung), Cluster HA (partial)
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14
Q

HA w/ photophobia and/or phonophobia

A

Migraine

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15
Q

HA w/ b/l frontal/occipital pressure

A

Tension

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16
Q

HA w/ lacrimation and/or rhinorrhea

A

Cluster

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17
Q

HA w/ elevated ESR

A

Temporal (giant cell) arteritis

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18
Q

“Worst HA of my life”

A

SAH

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19
Q

HA + extraocular muscle palsies

A

Cavernous sinus thrombosis

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20
Q

Scintillating scotomas prior to HA

A

Migraine w/ aura

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21
Q

HA associated with sex (before/after orgasm)

A

Post coital cephalgia

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22
Q

HA responsive to 100% O2

A

Cluster

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23
Q

Frontal HA made worse by bending over

A

Sinus

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24
Q

Trauma to head leading to HA that begins days later, persists for over a week and doesn’t go away

A

Subdural hematoma

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25
Q

Trigeminal neuralgia first line Rx

A

Carbamazepine

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26
Q

UMN s/sx

A

Spasticity, increased DTR, positive Babinski sign
Slowed rapid alternating movements, gait disorder
Movement stiffness, slowness, incoordination

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27
Q

LMN s/sx

A

Flaccid paralysis, decreased DTR, fasciculations, muscle atrophy
Weakness, gait disorder

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28
Q

Bulbar UMN s/sx

A

Dysphagia, dysarthria

Pseudobulbar: inappropriate laughing, crying, yawning

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29
Q

Two symptoms = MS

A

Unilateral optic neuritis

Internuclear ophthalmoplegia

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30
Q

Eye pain worse with movement, central vision loss, afferent pupillary defect

A

Optic neuritis –> MS

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31
Q

Ipsilateral loss of adduction on lateral gaze + contralateral nystagmus + intact convergence

A

Internuclear ophthalmoplegia –> MS

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32
Q

Marcus Gunn pupil

A

Optic nerve injury or retinal detachment
Fail swinging flashlight test
Afferent pupillary defect

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33
Q

Dementia with Parkinsonian features

A

Lewy body dementia

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34
Q

Dementia with visual hallucinations

A

Lewy body dementia

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35
Q

Dementia with syncope / repeated falls

A

Lewy body dementia

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36
Q

Dementia with behavior or personality changes

A

Frontotemporal dementia (Pick disease)

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37
Q

Dementia with progressive aphasia

A

Frontotemporal dementia (Pick disease)

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38
Q

Dementia work-up

A

MMSE
Electrolytes, BUN/Cr, LFT, Ca, CBC, UA, RPR, HIV, TSH, B12
MRI of brain

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39
Q

Bilateral facial weakness

A 
Guillain-Barre syndrome
Lyme disease (b/l Bell's palsy)
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40
Q

Upper and lower facial weakness

A

Bell’s palsy

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41
Q

Causes of Bell’s palsy

A

Lyme disease
Herpes Zoster, AIDS, sarcoid, tumors
Diabetes

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42
Q

Muscle weakness worse w/ use, what is next step?

A

Myasthenia gravis; CT chest for thymoma

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43
Q

Muscle weakness better w/ use, associated?

A

Lambert-Eaton; small cell lung cancer

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44
Q

Ptosis and Diplopia, young woman

A

Myasthenia gravis

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45
Q

Ascending bilateral weakness post recent viral illness

A

Guillain-Barre syndrome

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46
Q

Guillain-Barre associated viral illnesses

A

Campylobacter jejuni diarrhea (20%)

HIV, CMV, EBV, Mycoplasma, other viruses, immunizations (rare)

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47
Q

Chorea

A 
Hyperthyroidism
Huntington
SLE
Rheumatic fever
Levodopa use
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48
Q

Athetosis

A

Cerebral palsy

Encephalopathy, Huntington, Wilson

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49
Q

Dystonia

A

Parkinson
Neuroleptic use
Wilson, Huntington, encephalitis

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50
Q

Hemiballismus

A

Stroke (subthalamic nucleus)

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51
Q

Tics

A

Tourette syndrome

OCD, ADHD

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52
Q

MC brain tumors in adults

A 
MGM Studios
Metastases
Glioblastoma (prognosis = 6 months)
Meningtioma
Schwannoma
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53
Q

MC brain tumors in children

A

Animal Kingdom, Magic Kingdom, Epcot
Astrocytoma (benign)
Medulloblastoma (malignant)
Ependymoma (may be malignant)

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54
Q

Metastatic CNS neoplasms - from where

A 
Lots of Bad Stuff Kills Glia
Lung
Breast
Skin (melanoma)
Kidney (RCC)
GI (CRC)
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55
Q

Neurofibromatosis Type I - S/Sx

A 
AD on chromosome 17
COFFINS
Cafe-au-lait spots
Optic glioma
Freckling (axillary/inguinal)
Family hx
Iris hamartomas (Lisch nodules)
Neurofibromas
Skeletal lesions
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56
Q

Neurofibromatosis Type II

A

AD on chromosome 22

Bilateral acoustic neuromas (schwannomas) - hearing loss

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57
Q

Syncope causes

A 
Reflex (vasovagal, situational)
Carotid-sinus hypersensitivity
Cardiogenic
Orthostatic
Cerebrovascular
Idiopathic (>20%)
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58
Q

Syncope work-up

A 
Tilt test
R/o seizure by H&P
Cbc, electrolytes, BUN/Cr, glucose
Assess volume statis
Pulse ox and EKG
Evaluate medications
Carotid sinus massage (patients >40 w/o carotid disease or bruit)
Also consider: serial cardiac enzymes/EKG x3, echocardiogram, cardiac stress test, bilateral carotid duplex, 24 hr Holter monitor, CT head and EEG
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59
Q

Seizure vs syncope vs nonspecific

A

Prodrome of deja-vu, aura; postictal confusion, tongue lacerations vs Prodrome of sweating, lightheadedness; hx prolonged standing
Nonspecific: brief limb jerking, urinary incontinence

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60
Q

Diff Dx in ER for LOC

A 
AEIOU TIPS
Alcohol
Epilepsy/environmental (hypothermia)
Insulin (+/-)
OD/opioids
Uremia
Trauma
Infection
Psychogenic
Stroke
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61
Q

Arnold Chiari malformation associated abnormalities

A

Hydrocephalus
Syringomyelia
Myelomeningocele

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62
Q

RB gene

A

Retinoblastoma

Osteosarcoma

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63
Q

Cherry red spots on retina

A

Tay Sachs
Niemann-Pick
Central retinal artery occlusion

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64
Q

Hydrocephalus in children

A

Arnold Chiari type II

Dandy Walker malformation

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65
Q

Tay Sach’s disease

A

Ashkenazi Jews

Cherry red spot on retina

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66
Q

Blown/dilated pupil

A

CNIII lesion (parasympathetic fibers)

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67
Q

MLF syndrome (maintains conjugate gaze when one eye abducts)

A

Bilateral - MS

Unilateral - stroke

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68
Q

Bitemporal hemianopia

A

Optic chiasm lesion (pituitary adenoma)

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69
Q

Argyll Robertson pupil

A

Accommodates to near objects, nonreactive to light
Syphilis (prostitute’s eye)
SLE, DM

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70
Q

Adie pupil

A

Minimally reactive dilated pupil

Abnormal innervation of iris (usu inflammation from former infection)

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71
Q

Uveitis - associated diseases

A 
Seronegative spondyloarthropathies (-RF): psoriatic arthritis, ankylosing spondylitis, inflammatory bowel diseases (esp UC), reactive arthritis
Juvenile idiopathic arthritis
Behcet's disease, Sarcoidosis, Kawasaki disease
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72
Q

MCC blindness over age 55

A

Macular degeneration

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73
Q

MCC blindness under age 55

A

Diabetes mellitus

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74
Q

MCC blindness in blacks

A

Glaucoma

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75
Q

Bacterial conjunctivitis

A

Purulent, copious discharge 24 hrs/day

S. aureus, S. pneumo, N. gonorrhea, Chlamydia

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76
Q

Viral conjunctivitis

A

Watery discharge, eyelid may be sealed shut in AM
May also have fever, URI, lymphadenopathy, pharyngitis
Adenovirus

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77
Q

Conjunctivitis +/- diarrhea +/- URI

A

Adenovirus

78
Q

Allergic conjunctivitis

A

Bilateral watery discharge, eyelids may be sealed shut in AM

May also have pruritis, other allergy symptoms

79
Q

Red eye + may indicate collagen vascular disorder

A

Uveitis (or scleritis)

80
Q

Red eye w/ potential serious complication of corneal ulceration

A

Herpes simplex keratitis

81
Q

Red eye + colored halos

A

Acute angle-closure glaucoma

82
Q

Red eye + itching

A

Allergic conjunctivitis

83
Q

Red eye + preauricular LN enlargement

A

Viral conjunctivitis

84
Q

Red eye + “dry eyes”

A

Keratoconjunctivitis sicca (feature of Sjogren’s syndrome)

85
Q

Red eye + shallow anterior chamber

A

Acute angle-closure glaucoma

86
Q

Afferent defect

A

Optic nerve damage prior to pretectal nucleus
No constriction of either pupil w/ light in affected eye
Constriction of both pupils w/ light in non-affected eye

87
Q

Efferent defect

A

Oculomotor nerve damage
Affected pupil will not contract w/ light in either eye
Non-affected pupil contracts w/ light in either eye

88
Q

Diff dx for lens dislocation

A 
Marfan syndrome (dislocates upward)
Homocystinuria (dislocates downward)
Alport syndrome
89
Q

Vitamin A deficiency

A 
Night blindness (or complete)
Xerophthalmia
Bitot spots (areas of abnl squamous cell proliferation and keratinization of conjunctiva)
90
Q

Cotton wool spots

A

Retinal vein occlusion
Diabetes
HTN
HIV

91
Q

Diabetic retinopathy

A

Cotton wool spots
Lipid exudates
Proliferative or non-proliferative (blood vessels)

92
Q

Cupping of optic disc (>50%)

A

Open angle glaucoma

93
Q

MCC conductive hearing loss in adults

A

Otosclerosis

94
Q

MCC sensorineural hearing loss in adults

A

Presbycusis (high frequency bilateral)

95
Q

Meniere’s disease

A

Vertigo, tinnitus, low frequency hearing loss

96
Q

Ramsay Hunt syndrome

A

Herpes zoster oticus
Ipsilateral facial paralysis, ear pain, vesicles in auditory canal/auricle
Also abnl taste perception, tinnitus, vertigo, abnl lacrimation

97
Q

Otitis media organisms

A

S. pneumo
H. influenzae
Moraxella catarrhalis
S. pyogenes, viruses

98
Q

Otitis externa organisms

A

S. aureus
Pseudomonas
S. epidermis

99
Q

Subconsciously pushing memories out of conscious mind

A

Repression

100
Q

Consciously pushing memories out of conscious mind

A

Suppression

101
Q

Taking out frustrations on another target in socially inacceptable way

A

Displacement

102
Q

Taking out frustrations on another target in socially acceptable way

A

Sublimation

103
Q

Splitting and self-mutilation/suicide attempts

A

Borderline personality disorder

104
Q

Wants to be alone vs wants to be with others but is afraid

A

Schizoid vs Avoidant personality disorder

105
Q

CAGE questions

A

Cut down
Annoyance w/ others
Guilt
Eye-opener

106
Q

Wernicke-Korsakoff

A

Encephalopathy, eye problems, ataxia

Anterograde and retrograde amnesia, confabulations, hallucinations

107
Q

Aspiration pneumonia w/ alcoholics, organisms?

A

Anaerobes

Klebsiella

108
Q

Drug use - red eyes

109
Q

Drug use - horizontal and vertical nystagmus

A

PCP (some nystagmus w/ alcohol OD)

110
Q

Drug use - mydriasis (dilated pupils)

A

Cocaine
Amphetamines
LSD

111
Q

Drug use - miosis (pinpoint pupils)

A

Opioids (heroin, morphine, methadone)

Organophosphates

112
Q

Albuminiocytologic dissociation (increased protein w/ normal WBC in CSF)

A

Guillain-Barre syndrome

113
Q

MCC delirium in elderly

A

UTI

Meds (anticholinergics and benzos)

114
Q

MCC delirium, drugs

A

Corticosteroids
Benzodiazepines
Anticholinergics
Antihistamines

115
Q

DOC in delirium, dementia-related agitation

A

Haloperidol, low dose

NO benzos or anticholinergics (diphenhydramine) b/c they can worsen symptoms

116
Q

Atrophy of mammillary bodies

A

Wernicke encephalopathy

117
Q

Nausea and vomiting with NO diarrhea

A

NOT gastroenteritis

DKA in differential

118
Q

Leading cause of death in diabetes

A

Cardiac disease (esp from atherosclerosis)

119
Q

Causes of hypoglycemia

A 
Medications (in diabetics)
Fasting + underlying liver/hormone disorder/malnutrition
Alcohol abuse
Pituitary/adrenal insufficiency
Insulinoma
Factitious (medications)
Reactive (gastric bypass)
120
Q

Diagnostic criteria for DM

A

Random glucose >200 + symptoms
Fasting glucose >126 on 2 separate occasions
Glucose tolerance test >200 (2 hrs after 75 g oral glucose)
Hemoglobin A1C >6.5

121
Q

Acanthosis nigricans

A

Insulin resistance

or occult malignancies

122
Q

Metabolic syndrome criteria

A 
Three of five:
Abdominal obesity
TG >150
HDL 130/85
Fasting glucose >100 (or >140 GTT)
123
Q

Oral diabetic medication w/ rare lactic acidosis

124
Q

Oral diabetic medication w/ hypoglycemia

A

Sulfonureas, Meglitinides

125
Q

Oral diabetic medication also helps lower TG/LDL

126
Q

Oral diabetic medication not safe in CHF

A

TZDs (-glitazones)

127
Q

Oral diabetic medication shouldn’t be used in with elevated serum creatinine

128
Q

Oral diabetic medication shouldn’t be used in IBD

A

alpha-Glucosidase inhibitors (acarbose)

Also metformin, incretin analogs (not oral)

129
Q

Oral diabetic medication should monitor LFTs

A

Metformin (safe in mild liver disease)

130
Q

Oral diabetic medication w/ no weight gain

A

Metformin

Incretin mimetics, DPP-4 inhibitors, SGLT-2 inhibitors

131
Q

Oral diabetic medication metabolized by liver (excellent choice in renal insufficiency)

A

TZDs, DPP-4 inhibitors (-gliptins)

132
Q

DKA vs HHNS, workup

A

Glucose 300-800 vs >800 (often >1,000)
+AG met acidosis vs no acidosis
Type I or II DM vs Type II DM
ABG, check serum/urine ketones

133
Q

Causes (workup) of DKA or HHNS

A

Usu excess glucagon, catecholamines, corticosteroids
Infection (PNA, gastroenteritis, UTI, pancreatitis)
Medication reduction/omission
Severe medical illness (MI, CVA, trauma)
Undiagnosed DM (esp kids)
Dehydration
Alcohol or drug abuse
Corticosteroids
Blood/urine cx, UA, CXR, Tox screen, amylase/lipase, EKG, serial cardiac enzymes

134
Q

Charcot joint (chronic progressive arthropathy - severe foot deformity and joint destruction)

A 
Diabetic neuropathy
(Syphilis - tabes dorsalis - much less common)
135
Q

MCC hyperthyroidism

A

Graves disease

136
Q

Graves disease pathology

A

Autoimmune TSI antibodies that bind TSH receptors and stimulate thyroid hormone production

137
Q

Increases TBG levels

A

(Increased total T4, normal free T4)
Pregnancy
OCPs

138
Q

Decreases TBG levels

A

(Increased free T3/T4)

Hepatic failure, cirrhosis

139
Q

Causes of hyperthyroidism

A 
Graves disease
Toxic adenoma
Toxic multinodular goiter
Subacute thyroiditis (de Quervain thyroiditis)
Silent thyroiditis
Factitious thyroiditis
Amiodarone
Iodine ingestion (eg radiocontrast dye)
140
Q

Painful goiter

A

Subacute (deQuervain’s) thyroiditis

141
Q

Painless goiter

A

Hashimoto’s
graves disease
Silent thyroiditis

142
Q

MCC hypothyroidism

A

Hashimoto’s

143
Q

Pathology of Hashimoto’s thyroiditis

A

Anti-TPO (thyroid peroxidase) and antithyroglobulin antibodies (cell and Ab mediated attacks)

144
Q

Hypothyroidism labs

A

High TSH
Low T3 and T4
High LDL and total cholesterol

145
Q

Thyroid cancer forms

A

Papillary (MC, 78%) [Follicular MC variant, 17%]
Medullary
Anaplastic (worst prognosis)

146
Q

Papillary thyroid cancer

A

MC (78%), Follicular variant MC (17%)
Good prognosis
Usu younger patients

147
Q

Medullary thyroid cancer

A

Parafollicular C cells
Produces calcitonin
Associated w/ MEN IIa and IIb

148
Q

Anaplastic thyroid cancer

A

MC in older patients
Rock hard thyroid
Very aggressive, poor prognosis

149
Q

Common complications of thyroid surgery

A

Hoarseness (recurrent laryngeal n. damage)

Hypocalcemia (secondary hypoparathyroidism from surgical damage)

150
Q

Hypercalcemia

A

Stones, Bones, (Abdominal) Groans, Psychic overtones
Kidney stones
Osteitis fibrosis cystica, osteoporosis, osteomalacia, OA
Constipation, N/V, peptic ulcers, pancreatitis
Lethargy, fatigue, depression, memory loss, psychosis, personality changes confusion, stupor, coma
Other: proximal muscle weakness, keratitis, conjunctivitis, HTN, itching

151
Q

Medical conditions causing depression

A 
Hypothyroidism
Hyperparathyroidism (hypercalcemia)
Parkinson's
Stroke (esp ACA)
CNS neoplasms
Pancreatic cancer
Celiac disease
152
Q

Acute pancreatitis causes

A

Gallstones & alcohol
Hypercalcemia
Increased TGs

153
Q

Hypocalcemia

A 
Tingling in lips and fingers, dry skin, weakness, abdominal pain, tetany, dyspnea, possible tachycardia, seizures, movement disorders, cataracts, dental hypoplasia
Chvostek sign (facial nerve spasm), Trousseau sign (carpal spasm w/ BP cuff)
154
Q

Albright hereditary osteodystrophy

A

Shortening of 4th and 5th digits

Pseudohypoparathyroidism (no tissue response to PTH)

155
Q

MCC hypoparathyroidism

A

Surgical removal of PTH

AI gland degenration (uncommon)

156
Q

MCC primary hyperparathyroidism

A

Single adenoma
Hyperplasia of all 4 glands (less common)
PTH cancer (rare)

157
Q

Wacky, wet and wobbly

158
Q

Causes of hyperprolactinemia

A

Pregnancy
Prolactinoma (MC adenoma)
DA synthesis blocking drugs
Thyroid

159
Q

Progression of hormone deficiency in hypopituitarism

A

1) GH
2) LH, FSH
3) TSH
4) Prolactin
5) ACTH, MSH

160
Q

GH deficiency

A

Short stature/growth failure in children

161
Q

LH/FSH deficiency

A

Infertility, decreased libido, decreased pubic hair, amenorrhea (women), genital atrophy)

162
Q

TSH deficiency

A

Hypothyroidism w/ no goiter

163
Q

Prolactin deficiency

A

No pp lactation

164
Q

ACTH deficiency

A

Adrenal insufficiency - fatigue, weight loss, decreased appetite, poor response to stress

165
Q

MSH deficiency

A

Decreased skin pigment

166
Q

MC pituitary tumor

A

Prolactinoma

167
Q

Mineralocorticoid

A

Aldosterone

168
Q

Glucocorticoid

169
Q

MCC Cushing syndrome (top 3)

A

Excess corticosteroid administration
Ectopic ACTH (usu SCLC)
Pituitary adenoma ACTH production

170
Q

Cushing syndrome symptoms

A

Acne, hirsuitism, buffalo hump, moon facies;
Weakness, depression, menstrual irregularities, polydipsia, polyuria, increased libido, impotence;
Central obesity, purple striae on abdomen, cataracts

171
Q

Cushing syndrome labs

A

Hyperglycemia, glycosuria, hypokalemia

172
Q

HTN + Hypokalemia + Metabolic alkalosis

A

Hyperaldosteronism

173
Q

Cushing syndrome vs Conn syndrome

A

Excess cortisol

174
Q

Conn syndrome

A

Excess aldosterone secretion by unilateral adrenal adenoma (primary hyperaldosteronism)

175
Q

Addison disease

A

Adrenal cortical destruction caused by AI, infx, hemorrhage (primary adrenal insufficiency)

176
Q

Addison disease labs

A

Decreased Na, increased K
Eosinophilia
Decreased cortisol
ACTH increased (Addison) or decreased (2 or 3 insufficiency)

177
Q

Cosyntropin stimulation test

A

ACTH analog - decreased cortisol in 2 or 3 adrenal insufficiency, no response in Addison disease

178
Q

Addison / adrenal crisis

A

Severe weakness, fever, AMS, vascular collapse or shock

179
Q

17 alpha hydroxylase deficiency

A

(no aldosterone, +cortisol, +androgens)
Amenorrhea/ambiguous genitalia, HTN
Increased Na, decreased K, decreased androgens

180
Q

21 alpha hydroxylase deficiency

A 
(no aldosterone or cortisol, + androgens)
Ambiguous genitalia (female), virilization (female), precocious puberty (male), hypotension
Decreased Na, increased K, increased androgens
181
Q

11 beta hydroxylase deficiency

A 
(no aldosterone or cortisol, +precursors, + androgen)
Ambiguous genitalia (female), virilization (female), precocious puberty (male), HTN
Increased deoxycorticosterone, increased deoxycortisol, increased androgens
182
Q

Congenital adrenal hyperplasia symptoms

A

First 1 = HTN

Second 1 = virilization/ambiguous genitalia (female), precocious puberty (male) = +androgens

183
Q

MC form CAH

A

21 alpha hydroxylase deficiency

184
Q

Pheochromocytoma symptoms

A

Intermittent HTN, diaphoresis, HA; tachycardia, palpitations, CP, anxiety

185
Q

RET proto-oncogene mutation

A

MEN IIa and IIb

186
Q

MEN type I

A

3 Ps
Parathyroid adenoma
Pancreas tumors (endocrine)
Pituitary

187
Q

Hypercalcemia + peptic ulcer disease

A

Common presentation of MEN I

188
Q

MEN type IIa

A

2 Ps, 1 M
Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid cancer

189
Q

MEN type IIb

A

1 P, 2 Ms
Pheochromocytoma
Medullary thyroid cancer
Mucosal neuromas

190
Q

Eosinophilia causes

A 
DNA AACP
Drugs
Neoplasms
Allergic (allergies, asthma, Churg-Strauss)
Addison disease
AIN (acute interstitial nephritis)
CVD (collagen vascular disease)
Parasites (eg Loefflers, ascaris lumbricoides)

Step 2 DIT 😱 (23 decks)

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